a. Their inherency disproves solvency – If health workers are currently leaving Africa because they can get higher salaries in developed countries, then post-plan developed countries will further raise wages to attract these health workers. This is a 100% solvency takeout. All of their solvency evidence refers to specific instances when the wages of one community were raised. In those cases developed countries could continue to draw employees from the rest of low-wage Africa.
b. We have evidence on our side. Empirically, Africans will choose higher wages offered by developed countries over small increases in their home country wages
Richard Record, corresponding author, 12/18/06. “An economic perspective on Malawi's medical "brain drain"” Global Health. Lexis.
Interestingly, the same document notes that in as recently as 1997/98 the level of vacancies for skilled staff was just 4.8 percent and there were no vacancies at all at the senior levels. Hence, the "medical brain drain" is a relatively new phenomenon as far as Malawi is concerned. In October 2004, the Government of Malawi launched a major Sector-wide Approach (SWAp) for the health sector that attempted to revitalise Malawi's health services and support the delivery of the Essential Health Package. The SWAp programme of work saw the pooling of funds from major donors to the sector (UK, Norway and the World Bank) into the Ministry of Health budget to cover delivery of the EHP, strengthening of human resources, and systems strengthening and referral over a seven year period. The total cost of the SWAp is USD 735.7 million, of which 71 percent is to be provided by external donors [12]. The Government of Malawi also committed itself to raising the share of Government spending allocated to health from 11.2 percent in the 2002/03 budget to 13.5 percent by the end of the programme in 2009/10. 40 percent of the cost of the SWAp is allocated to strengthening human resources, of which a significant proportion is targeted towards raising the salaries of Malawi's public health workers. Table 2 shows the pre-October 2004 salaries for selected grades, and the post-October 2004 salaries which include changes in the official salary and a top-up funded using UK contributions to the SWAp. Senior physicians have seen the most dramatic increases in salaries and the gross P4 monthly salary has risen from USD 243 to USD 1,600. However, salaries at most grades have risen to the order of 40–60 percent. Mid-level nurse gross monthly salaries have risen from USD 108 to USD 190. Yetthe reality is that the remuneration gap for skilled medical staff between say, theUKandMalawiis so great, that these increases are likely to do little to reduce the incentives for staff to migrate. In the UK a newly qualified nurse earns £19,166 (USD 33, 290), a new junior physician £30,433 (USD 52,871), and a new senior physician £69,991 (USD 121,556) [14]. For newly qualified nurses, junior doctors and senior physicians this is still equivalent to around ten or more times the equivalent in Malawi. Hence it is hardly surprising that the exodus continues. However, to be fair the primary objective of the SWAp-funded salary top-up is not to compete with international labour markets, but to lift Malawi's health workers out of poverty, to ensure that workers receive at least a "satisfying level of income", and to discourage workers from leaving the health profession within Malawi.
2. Turn – a rapid increase in medical workers overwhelms African countries & lowers the quality of care
Pooja Kumar, M.D. resident at the Harvard Affiliated Medical Residency. 6/21/07. “Providing the Providers — Remedying Africa's Shortage of Health Care Workers” The New England Journal of Medicine. Volume 356:2564-2567. No. 25. http://content.nejm.org/cgi/content/full/356/25/2564
Though additional health workers will be necessary for any solution, simply churning out more members of the workforce will not be enough. Workers will need to be adequately trained and equipped to make a difference to their patients. Increasing numbers of trainees may also overload the existing training programs in critical countries. Zimbabwe, for example, "has doubled or tripled enrollment in medical schools," according to Friedman, "but they haven't increased the number of professors. This is probably going to lead to lower quality."
3. Alternate causalities to health – even if they raise salaries lack of equipment and protection from diseases will dilute health worker effectiveness
What has caused this shortage in Africa? Simply put, African health care workers are all too often unable to meet their own needs or those of their patients. Their salaries are inadequate. They lack the supplies and gear to protect them from acquiring HIV while on the job, and often lack access to confidential health services for themselves for HIV-related health services. They face tremendous stress at work. Their training does not prepare them for the conditions in which they find themselves, and they have too few opportunities to develop themselves professionally. Poor management contributes to late pay, poor supervision, and other troubles that interfere with their own job satisfaction and their ability to care for their patients. Meanwhile, health care workers often face the unbearable situation where they have training to help their patients, but cannot do so because they lack basic medicines, supplies, and equipment. Many of the solutions to this shortage are readily understood once the causes of health worker disaffection are identified: living wages and decent benefits; effective infection prevention and control, including gloves and other gear to protect health workers from HIV and other occupational infections, along with post-exposure prophylaxis; psychosocial support and health care, including confidential health services; better pre-service training and professional development opportunities and clearer career paths; better supervision and management, and; the investments in basic infrastructure that will ensure that health care workers have the medicines, supplies, and equipment needed to perform their jobs.
Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
5. Brain Drain good – it relieves unemployment and increases developing nations’ competitiveness
Others argue that international migration encourages economic development and benefits both sending and receiving countries. Obviously, developed economies benefit by improving their global competitiveness through importing both the skilled and unskilled labour they need. Another view is that in Africa’s stagnating and deteriorating economies, emigration contributes to development by relieving unemployment and providing remittances from abroad that increase the supply of needed foreign exchange. It is pointed that the flows between African and developed countries do not go just one way. Africa is also the recipient of highly skilled labour migrants from developed countries from such sources as the Peace Corps, USAID, the World Bank, the UN, and staff of multinational corporations.
6. Alternate causalities: Violence, pursuit of a better family environment and better career options will continue to drive health workers away
Deena Guzder. dual-degree graduate student at Columbia University who is studying journalism and international affairs 2007. “Abandoning the Destitute to Heal the Wealthy: The Medical "Brain Drain" Phenomenon in the Context of Globalization” Michigan Journal of Public Affairs http://www.mjpa.umich.edu/articles/07-4-Guzder.html
Medical professionals in the global South are dissuaded from remaining stationary for many reasons. A collaborative study published by the Lancet Medical Journal observes: “Nearly all countries [experiencing brain drain] are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base” (Chen et al 2004). Other key reasons for emigrating are personal ones. These include security, the threat of violence, and the wish to provide a good education for their children (Pang, Lansang, and Haines 2002, 499-500). In this paper, we consider the following factors pushing doctors towards the global North: poor economic benefits, limited career opportunities, and substandard working conditions. According to Harvard University’s Dr. Amitabh Chandra, “Many articles in the field of economics demonstrate that income discrepancies between donor and recipient nations are the principal determinant of decisions regarding migration” (Chandra 2006). The disparities are so stark that some doctors in developing countries are even willing to retrain as nurses in order to secure positions in developed countries. This phenomenon has been called “brain waste.” Two physicians at the University Hospitals of Cleveland note:m"A disheartening development in the Philippines is the increasing number of physicians who are retraining to become nurses. Most doctors there receive an annual salary equivalent to less than a month's pay for a nurse in a U.S. hospital. Immigration to the United States for nurses is much simpler than it is for physicians. Since the year 2000, more than 3500 Filipino physicians have taken accelerated nursing courses and have left for nursing jobs abroad. More than 4000 physicians are now in nursing school. These students include not just new physicians but internists, surgeons, anesthesiologists, family practitioners, and subspecialists" (Galvez, Sanchez, and Balanon 2004). Ambitious physicians’ desires to seek better opportunities are understandable and it is important to recognize that the brain drain phenomenon is largely the result of a tilted playing field where some locations provide far greater economic stability than others. Demoralized from long hours in cramped spaces for little pay and patients, many doctors choose to migrate to the developed world. Medical brain drain is not simply fueled by the economic self-interest of health professionals but also the desire for better academic opportunities that would make these doctors better practitioners. Dr. Uzor C. Ogbu brings up a compelling point in a letter to the New England Journal of Medicine: “Given the limited number of residency positions in the source countries, if the migrating physicians . . . had stayed home, they might not have attained the qualifications they now hold” (Domingo and Salvana 2006). Therefore simply mandating that potential doctors remain stationary will not alleviate medical brain drain unless such legislation is coupled with a plan for strengthening residency programs. Dr. Gökmen Gemici raises a similar concern, “One of the major problems of being a physician or scientist in a developing country is the shortage of academic opportunities” (Domingo and Salvana 2006). In assessing the metrics of medical brain drain, Dr. Fitzhugh Mullan notes, “Medical-training positions in these developed nations, as well as opportunities for medical employment, have proved a strong draw for physicians from many nations” (Mullan 2005). In light of these doctors’ general consensus, we may add not just individual advancement but also the lack of advanced medical training venues in developing countries to our growing list of “donor country problems.”
7. Turn – dependency. Too much foreign aid forces countries to give inadequate care because of the dictations of donors
Regardless of whether these problems proliferate, it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health. Ministries of health in poor countries face increasing competition from NGOs and relief agencies but almost none from their local private sectors. This should be troubling, because if no locals can profit legitimately from any aspect of health care, it is unlikely that poor countries will ever be able to escape dependency on foreign aid. Finally, major influxes of foreign funding can raise important questions about national control and the skewing of health-care policies toward foreign rather than domestic priorities. Many governments and activists complain that the U.S. government, in particular, already exerts too much control over the design and emphasis of local HIV/AIDS programs. This objection is especially strong regarding HIV-prevention programs, with claims that the Bush administration has pushed abstinence, fidelity, and faith-based programs at the expense of locally generated condom- and needle-distribution efforts. Donor states need to find ways not only to solve the human resource crisis inside poor countries but also to decrease their own dependency on foreign health-care workers.
8. The brain drain is irrelevant in the 21st century. Doctors can travel, and use high tech technology.
Sunita Dodani, Department of Epidemiology & Ronald LaPorte. 2005. “Brain drain from developing countries: how can brain drain be converted into wisdom gain?” Journal of the Royal Society of Medicine. http://www.jrsm.org/cgi/content/full/98/11/487
It is time to understand and accept that health professionals’ mobility is part of life in the 21st century. Countries need to recognize that they compete with the best institutions in the world for quality manpower. It is time to bury the archaic concept of brain drain and turn to assessing the performance of health professionals and systems, wherever they are in the world. The turn of the 21st century has not only brought technology, but also modes by which scientists around the world can be connected in no time. In this globalized world the physical location of a person may or may not have any relation to the ability to make an impact on human health. Health professionals in the developed world may have most of their work portfolios in the developing world. Easy communication, quick travel, and greater collaborations between developed and developing countries are increasingly more common and we need to develop ways in which foreign professionals can contribute to their countries of origin.
1. No Solvency
a. Their inherency disproves solvency – If health workers are currently leaving Africa because they can get higher salaries in developed countries, then post-plan developed countries will further raise wages to attract these health workers. This is a 100% solvency takeout. All of their solvency evidence refers to specific instances when the wages of one community were raised. In those cases developed countries could continue to draw employees from the rest of low-wage Africa.
b. We have evidence on our side. Empirically, Africans will choose higher wages offered by developed countries over small increases in their home country wagesRichard Record, corresponding author, 12/18/06. “An economic perspective on Malawi's medical "brain drain"” Global Health. Lexis.
Interestingly, the same document notes that in as recently as 1997/98 the level of vacancies for skilled staff was just 4.8 percent and there were no vacancies at all at the senior levels. Hence, the "medical brain drain" is a relatively new phenomenon as far as Malawi is concerned. In October 2004, the Government of Malawi launched a major Sector-wide Approach (SWAp) for the health sector that attempted to revitalise Malawi's health services and support the delivery of the Essential Health Package. The SWAp programme of work saw the pooling of funds from major donors to the sector (UK, Norway and the World Bank) into the Ministry of Health budget to cover delivery of the EHP, strengthening of human resources, and systems strengthening and referral over a seven year period. The total cost of the SWAp is USD 735.7 million, of which 71 percent is to be provided by external donors [12]. The Government of Malawi also committed itself to raising the share of Government spending allocated to health from 11.2 percent in the 2002/03 budget to 13.5 percent by the end of the programme in 2009/10. 40 percent of the cost of the SWAp is allocated to strengthening human resources, of which a significant proportion is targeted towards raising the salaries of Malawi's public health workers. Table 2 shows the pre-October 2004 salaries for selected grades, and the post-October 2004 salaries which include changes in the official salary and a top-up funded using UK contributions to the SWAp. Senior physicians have seen the most dramatic increases in salaries and the gross P4 monthly salary has risen from USD 243 to USD 1,600. However, salaries at most grades have risen to the order of 40–60 percent. Mid-level nurse gross monthly salaries have risen from USD 108 to USD 190. Yet the reality is that the remuneration gap for skilled medical staff between say, the UK and Malawi is so great, that these increases are likely to do little to reduce the incentives for staff to migrate. In the UK a newly qualified nurse earns £19,166 (USD 33, 290), a new junior physician £30,433 (USD 52,871), and a new senior physician £69,991 (USD 121,556) [14]. For newly qualified nurses, junior doctors and senior physicians this is still equivalent to around ten or more times the equivalent in Malawi. Hence it is hardly surprising that the exodus continues. However, to be fair the primary objective of the SWAp-funded salary top-up is not to compete with international labour markets, but to lift Malawi's health workers out of poverty, to ensure that workers receive at least a "satisfying level of income", and to discourage workers from leaving the health profession within Malawi.
2. Turn – a rapid increase in medical workers overwhelms African countries & lowers the quality of care
Pooja Kumar, M.D. resident at the Harvard Affiliated Medical Residency. 6/21/07. “Providing the Providers — Remedying Africa's Shortage of Health Care Workers” The New England Journal of Medicine. Volume 356:2564-2567. No. 25. http://content.nejm.org/cgi/content/full/356/25/2564Though additional health workers will be necessary for any solution, simply churning out more members of the workforce will not be enough. Workers will need to be adequately trained and equipped to make a difference to their patients. Increasing numbers of trainees may also overload the existing training programs in critical countries. Zimbabwe, for example, "has doubled or tripled enrollment in medical schools," according to Friedman, "but they haven't increased the number of professors. This is probably going to lead to lower quality."
3. Alternate causalities to health – even if they raise salaries lack of equipment and protection from diseases will dilute health worker effectiveness
Physicians for Human Rights. a member of the International Federation of Health and Human Rights Organisations (IFHHRO), January 2005. “Submission to the Commission for Africa” www.healthgap.org/camp/hcw_docs/PHR_CFA_HCW_submission.docWhat has caused this shortage in Africa? Simply put, African health care workers are all too often unable to meet their own needs or those of their patients. Their salaries are inadequate. They lack the supplies and gear to protect them from acquiring HIV while on the job, and often lack access to confidential health services for themselves for HIV-related health services. They face tremendous stress at work. Their training does not prepare them for the conditions in which they find themselves, and they have too few opportunities to develop themselves professionally. Poor management contributes to late pay, poor supervision, and other troubles that interfere with their own job satisfaction and their ability to care for their patients. Meanwhile, health care workers often face the unbearable situation where they have training to help their patients, but cannot do so because they lack basic medicines, supplies, and equipment. Many of the solutions to this shortage are readily understood once the causes of health worker disaffection are identified: living wages and decent benefits; effective infection prevention and control, including gloves and other gear to protect health workers from HIV and other occupational infections, along with post-exposure prophylaxis; psychosocial support and health care, including confidential health services; better pre-service training and professional development opportunities and clearer career paths; better supervision and management, and; the investments in basic infrastructure that will ensure that health care workers have the medicines, supplies, and equipment needed to perform their jobs.
4. Turn - Artificially increasing wages widens inequality and perpetuates poverty.
Laurie **Garrett**. science and health writer, winner of the Pulitzer, Polk, and Peabody Prize. January/ February 2007. “The Challenge of Global Health” Foreign Affairs.http://www.foreignaffairs.org/20070101faessay86103-p30/laurie-garrett/the-challenge-of-global-health.html
Some analysts, meanwhile, insist that massive infusions of foreign cash into the public sector undermine local manufacturing and economic development. Thus, Arvind Subramanian, of the IMF, points out that all the best talent in Mozambique and Uganda is tied up in what he calls "the aid industry," and, he says, foreign-aid efforts suck all the air out of local innovation and entrepreneurship. {See Footnote 1} A more immediate concern is that raising salaries for health-care workers and managers directly involved in HIV/AIDS and other health programs will lead to salary boosts in other public sectors and spawn inflation in the countries in question. This would widen the gap between the rich and the poor, pushing the costs of staples beyond the reach of many citizens. If not carefully managed, the influx of cash could exacerbate such conditions as malnutrition and homelessness while undermining any possibility that local industries could eventually grow and support themselves through competitive exports.
5. Brain Drain good – it relieves unemployment and increases developing nations’ competitiveness
April Gordon. Department of Sociology at Winthrop. Spring 1998. “The new diaspora-African immigration to the United States” Journal of Third World Studies. http://findarticles.com/p/articles/mi_qa3821Others argue that international migration encourages economic development and benefits both sending and receiving countries. Obviously, developed economies benefit by improving their global competitiveness through importing both the skilled and unskilled labour they need. Another view is that in Africa’s stagnating and deteriorating economies, emigration contributes to development by relieving unemployment and providing remittances from abroad that increase the supply of needed foreign exchange. It is pointed that the flows between African and developed countries do not go just one way. Africa is also the recipient of highly skilled labour migrants from developed countries from such sources as the Peace Corps, USAID, the World Bank, the UN, and staff of multinational corporations.
6. Alternate causalities: Violence, pursuit of a better family environment and better career options will continue to drive health workers away
Deena Guzder. dual-degree graduate student at Columbia University who is studying journalism and international affairs 2007. “Abandoning the Destitute to Heal the Wealthy: The Medical "Brain Drain" Phenomenon in the Context of Globalization” Michigan Journal of Public Affairshttp://www.mjpa.umich.edu/articles/07-4-Guzder.html
Medical professionals in the global South are dissuaded from remaining stationary for many reasons. A collaborative study published by the Lancet Medical Journal observes: “Nearly all countries [experiencing brain drain] are challenged by worker shortage, skill mix imbalance, maldistribution, negative work environment, and weak knowledge base” (Chen et al 2004). Other key reasons for emigrating are personal ones. These include security, the threat of violence, and the wish to provide a good education for their children (Pang, Lansang, and Haines 2002, 499-500). In this paper, we consider the following factors pushing doctors towards the global North: poor economic benefits, limited career opportunities, and substandard working conditions. According to Harvard University’s Dr. Amitabh Chandra, “Many articles in the field of economics demonstrate that income discrepancies between donor and recipient nations are the principal determinant of decisions regarding migration” (Chandra 2006). The disparities are so stark that some doctors in developing countries are even willing to retrain as nurses in order to secure positions in developed countries. This phenomenon has been called “brain waste.” Two physicians at the University Hospitals of Cleveland note:m"A disheartening development in the Philippines is the increasing number of physicians who are retraining to become nurses. Most doctors there receive an annual salary equivalent to less than a month's pay for a nurse in a U.S. hospital. Immigration to the United States for nurses is much simpler than it is for physicians. Since the year 2000, more than 3500 Filipino physicians have taken accelerated nursing courses and have left for nursing jobs abroad. More than 4000 physicians are now in nursing school. These students include not just new physicians but internists, surgeons, anesthesiologists, family practitioners, and subspecialists" (Galvez, Sanchez, and Balanon 2004). Ambitious physicians’ desires to seek better opportunities are understandable and it is important to recognize that the brain drain phenomenon is largely the result of a tilted playing field where some locations provide far greater economic stability than others. Demoralized from long hours in cramped spaces for little pay and patients, many doctors choose to migrate to the developed world. Medical brain drain is not simply fueled by the economic self-interest of health professionals but also the desire for better academic opportunities that would make these doctors better practitioners. Dr. Uzor C. Ogbu brings up a compelling point in a letter to the New England Journal of Medicine: “Given the limited number of residency positions in the source countries, if the migrating physicians . . . had stayed home, they might not have attained the qualifications they now hold” (Domingo and Salvana 2006). Therefore simply mandating that potential doctors remain stationary will not alleviate medical brain drain unless such legislation is coupled with a plan for strengthening residency programs. Dr. Gökmen Gemici raises a similar concern, “One of the major problems of being a physician or scientist in a developing country is the shortage of academic opportunities” (Domingo and Salvana 2006). In assessing the metrics of medical brain drain, Dr. Fitzhugh Mullan notes, “Medical-training positions in these developed nations, as well as opportunities for medical employment, have proved a strong draw for physicians from many nations” (Mullan 2005). In light of these doctors’ general consensus, we may add not just individual advancement but also the lack of advanced medical training venues in developing countries to our growing list of “donor country problems.”
7. Turn – dependency. Too much foreign aid forces countries to give inadequate care because of the dictations of donors
Laurie **Garrett**. science and health writer, winner of the Pulitzer, Polk, and Peabody Prize. January/ February 2007. “The Challenge of Global Health” Foreign Affairs.http://www.foreignaffairs.org/20070101faessay86103-p30/laurie-garrett/the-challenge-of-global-health.html
Regardless of whether these problems proliferate, it is curious that even the most ardent capitalist nations funnel few if any resources toward local industries and profit centers related to health. Ministries of health in poor countries face increasing competition from NGOs and relief agencies but almost none from their local private sectors. This should be troubling, because if no locals can profit legitimately from any aspect of health care, it is unlikely that poor countries will ever be able to escape dependency on foreign aid. Finally, major influxes of foreign funding can raise important questions about national control and the skewing of health-care policies toward foreign rather than domestic priorities. Many governments and activists complain that the U.S. government, in particular, already exerts too much control over the design and emphasis of local HIV/AIDS programs. This objection is especially strong regarding HIV-prevention programs, with claims that the Bush administration has pushed abstinence, fidelity, and faith-based programs at the expense of locally generated condom- and needle-distribution efforts. Donor states need to find ways not only to solve the human resource crisis inside poor countries but also to decrease their own dependency on foreign health-care workers.
8. The brain drain is irrelevant in the 21st century. Doctors can travel, and use high tech technology.
Sunita Dodani, Department of Epidemiology & Ronald LaPorte. 2005. “Brain drain from developing countries: how can brain drain be converted into wisdom gain?” Journal of the Royal Society of Medicine. http://www.jrsm.org/cgi/content/full/98/11/487It is time to understand and accept that health professionals’ mobility is part of life in the 21st century. Countries need to recognize that they compete with the best institutions in the world for quality manpower. It is time to bury the archaic concept of brain drain and turn to assessing the performance of health professionals and systems, wherever they are in the world. The turn of the 21st century has not only brought technology, but also modes by which scientists around the world can be connected in no time. In this globalized world the physical location of a person may or may not have any relation to the ability to make an impact on human health. Health professionals in the developed world may have most of their work portfolios in the developing world. Easy communication, quick travel, and greater collaborations between developed and developing countries are increasingly more common and we need to develop ways in which foreign professionals can contribute to their countries of origin.